Triple Choice Enrollment

THE BASICS

DEFINITIONS HMO (Health Maintenance Organization): A form of health insurance combining a range of coverage in a group basis. A group of doctors & other medical professionals offer care through the HMO for a flat monthly rate with no deductibles. All visits, prescriptions and other care must be approved by the HMO in order to be covered. There is no out of network coverage.

DEFINITIONS, cont’d PPO (Preferred Provider Organization): A health care organization composed of physicians, hospitals and other providers who provide health care services at a reduced fee. PPO’s allow for visits to out of network professionals at a greater expense to the policy holder. There is often a deductible in a PPO model.

DEFINITIONS, cont’d Deductible: The flat amount a group member must pay before the insurer will make any benefit payments. GHC = $0 deductible WPS Southern = $250 Single/$500 Family WPS Statewide = $400 Single/$800 Family

DEFINITIONS, cont’d Coinsurance: A method of cost-sharing in a health insurance policy that requires a group member to pay a stated percentage of all remaining eligible medical expenses after the deductible amount has been paid. GHC – 100% in-network, no out-of-network coverage WPS Southern/Statewide – 100% in-network, 70% out-of-network

DEFINITIONS, cont’d Co-pay: The flat fee that you pay at the point of service to share in the cost of covered medical services. Co-pays often apply to office visits and prescription drugs.

DEFINITIONS, cont’d Out of Pocket Maximum: Dollar amount set by the insurance carrier that limits the amount a member has to pay out of pocket for particular healthcare services during a particular time period. GHC – None In-Network, WPS Southern = $250 single/$500 family In-Network, WPS Statewide = $400 single/$800 family Out-of-Network, WPS Southern & Statewide = 30% to $1500 single/$3000 family

Deductible Coinsurance & Co-pays Reach Out-of-Pocket Maximum Plan Pays 100%... Co-pays still Apply

Primary Care vs. Specialty Care Primary Care Provider (PCP) – non-specialized physicians whose primary practice is one of the following: -Family Practice -Internal Medicine -General Practice -OB/GYN-Pediatrics-Psychologist-Psychiatrist

Primary Care vs. Specialty Care Specialty Provider – any physician whose primary practice is other than those listed on the previous page. Some examples include: -Physical Therapist -Chiropractor-Podiatrist-Cardiologist-Surgeon -Oral Surgeon

GHC HIGHLIGHTS Rates remain the same Employee premium contribution remains at 4% $0 deductible plan Complementary Medicine benefit Refer to the Notice of Benefit Changes included in the mailing for other benefit changes implemented by GHC.

WPS CHANGES

WPS SOUTHERN PPO HIGHLIGHTS More cost-efficient network with access to clinics & hospitals in a 12 county area in the southern region of WI. Includes Dean & Meriter, but does not include UW Health as “in-network”. 4% employee premium contribution In-network office visits – no deductible (specialty care - $30 co-pay) “Find a doctor” demonstration on WPS website

WPS Plan Design Changes Statewide – 8% employee premium contribution Statewide – deductible changed to $400/single $800/family Statewide Out of Pocket Max - $400/$800 in-network, $1,500/$3,000 out-of-network Southern Out of Pocket Max - $250/$500 in-network, $1,500/$3,000 out-of-network

WPS Plan Design Changes Southern/Statewide -Office co-pay: $0 PCP, $30 Specialty – deductible does not have to be met -Coinsurance: 100% in-network, 70% out-of- network -Prescriptions: $5 generic, $20 preferred brand, $35 non-preferred brand. Please consider mail- order for your maintenance drugs. It can mean 3 months for the price of 2 months!

Please find additional information in the Triple Choice Enrollment Toolkit on the College website at:

Questions?